Posts Tagged ‘Kaiser Health News’

Handicapping the ACA’s Fate

Wednesday, June 13th, 2012

As the nation anticipates the Supreme Court decision on the future of the Patient Protection and Affordable Care Act (ACA),  pointed questioning by justices has supporters and opponents facing the possibility that the law could be declared unconstitutional.  That would eliminate — along with the contentious mandate that people purchase health insurance — popular provisions such as letting young adults stay on their parents’ plans until age 26, making prescription drugs more affordable for seniors, and requiring insurers to cover those with pre-existing medical conditions.

Even if the court keeps most of the law intact and strikes down the individual mandate, many healthcare advocates, insurers, and legislators believe that these consumer protections will be meaningless.  “There are a series of provisions of the law which have already been enacted which have proven to be fairly popular,’’ said Andrew Dreyfus, president and CEO of Blue Cross Blue Shield of Massachusetts.  “The question nationally is will there be bipartisan consensus to maintain those provisions even if the Supreme Court overturns some aspects of the law or the whole law?’’

Congress has been disinclined to talk about contingency plans, or the possibility of compromise.  There is agreement  that nothing will be done before November’s presidential election.  “Repeal and replace is a good slogan, but what kind of replacement are we talking about?’’ asked Gail Wilensky, a healthcare economist who administered Medicare and Medicaid under George H.W. Bush.  “Is it a replacement that will substantially extend coverage for people who have been uninsured?  At the moment it’s a little hard to see that happening.’’

“It’s a standard rule of politics that people value losses more than hypothetical gains,’’ said John McDonough, director of Harvard University’s Center for Public Health Leadership and who helped the Senate write the ACA.  “If the court were to strike down significant parts of the law that are already in place, there could quite possibly be a potent public reaction against what is being taken away from people.’’

In an interview with Kaiser Health News, Jon Kingsdale, Executive Director of the Commonwealth Health Insurance Connector Authority, who is working to implement the ACA said “We’re working with about a dozen states, and they fall, I’d say, into three camps: One, working very, very hard with a real strong vision of what they want to set up, to implement by October 1, 2013 – which is less than 18 months away.  Others that are planning – they’re preparing.  They’re waiting to see, in fact, if it’s implemented after the Supreme Court decision, which is expected to be announced in June – and/or the election in November.  And then there are states, frankly, we are not working with that are pretty much waiting to see this go away.”

Kingsdale believes that the entire law will not be thrown out by the Supreme Court.  “I think their striking down the entire law is much less probable than striking down the mandate,” he said.  “I’ve begun to talk to people in insurance companies and states and vendor organizations about what happens if the entire law is struck down, and I am struck by the lack of anticipation of what that would mean.  People are aware that there are huge problems. There are many things that have been implemented already, in terms of insurance coverage and Medicare payment policies and accountable care organizations, the authorization of which would be undercut.”

David Axelrod, chief campaign strategist to President Barack Obama, is denying reports that the White House may revisit healthcare in his second term.  “Our hope and our expectation is that the Supreme Court will affirm the healthcare law,” Axelrod said.  “Now is not the time to speculate on that.  We believe that the law is constitutional.  The Affordable Care Act is also really important to the health and well-being of the American people,” Axelrod said. “It is already helping people all over this country, and has improved the position of people relative to their insurance companies, and the kind of policies they are getting and the return they are getting for the premiums they are paying.”

10 Percent of America’s Veterans Have No Healthcare Coverage

Tuesday, June 12th, 2012

Ten percent of the nation’s 12.5 million non-elderly veterans do not have health insurance coverage or use Veterans Administration (VA) health care according to the 2010 American Community Survey (ACS).  The Urban Institute report, which was released by the Robert Wood Johnson Foundation, is the first to provide estimates of a lack of insurance among veterans and their families both nationally and at the state level, and to assess the potential for the Patient Protection and Affordable Care Act (ACA) to reduce these rates.  Veterans are less likely be uninsured than the overall population.  Uninsured veterans and their families report significantly less access to healthcare than their counterparts with insurance coverage.  Forty-one percent of veterans who lack healthcare coverage have untreated medical needs, while nearly 34 percent have put off getting care because of the expense.

The ACA’s coverage provisions have the potential to increase coverage among the U.S. population, including uninsured veterans.  An estimated 50 percent of veterans who currently do not have insurance would qualify for expanded Medicaid coverage; another 40 percent have the potential to receive subsidized coverage through health insurance exchanges if they lack access to affordable employer coverage.  Not surprisingly states that have made minimal progress in setting up health insurance exchanges have the most uninsured veterans — nearly 40 percent.  Success in bringing coverage to uninsured veterans will depend primarily on aggressive ACA implementation and enrollment efforts.

The Veterans Administration (VA) –  with more than 1,400 hospitals nationally and nearly 15,000 physicians – covers the majority of veterans, although not all: Eligibility is determined by income, injuries sustained in combat and length of service.  Because of the eligibility requirements, 1.3 million veterans and 0.9 million family members have no healthcare coverage.

Uninsured veterans typically are younger than those with coverage and less likely to have been injured in combat.  Uninsured veterans tend to have higher unemployment rates, less income and usually are not married — all of which reduce the odds of having private coverage.  “Their lower likelihood of being full-time workers and being married likely contribute to their lack of coverage, as these attributes are characterized by lower access to employer-sponsored health insurance,” according to the Urban Institute study.

Writing for the Non-Profit Quarterly, Rick Cohen notes that “Among the states with the worst rates of uninsured veterans, Louisiana, Oregon, and Idaho all top 14 percent, and Montana comes in at a woeful 17.3 percent.  This past weekend, the streets of Washington, D.C. were occupied by participants in the Rolling Thunder demonstration, the annual Memorial Day gathering of veterans (and non-veterans) on motorcycles focused on calling the nation’s attention to the POW/MIA issue.  The Robert Wood Johnson Foundation report would suggest that, in the U.S., there is an abundance of veterans and their families who are being treated as if MIA when it comes to health insurance.”

According to Dr. Jonathan D. Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne,  “A Harvard study estimated that more than 2,200 veterans died in 2008 due to lack of insurance.  You may have thought that veterans can automatically be treated at a veterans’ hospital, but this is not the case.  Uninsured veterans face a “means test” based on their income.  The test determines their priority level for care and how much they have to pay.  And if the system doesn’t have enough money, it can stop enrolling veterans if they fail the means test – as happened from 2003 to 2009.  But even if the VA were able to fully cover every veteran, it would still leave a lot of veterans without care because they do not live near a VA hospital.  And even if they live near a hospital, they still may need to drive far away to get services that aren’t available locally.  There are laws that make it illegal for an insurance company to force patients to drive an excessive distance to stay in their network, yet we think nothing of making veterans drive long distances simply to get the care to which they are entitled.”

Sick Americans Worry About the Cost of Their Healthcare

Tuesday, June 5th, 2012

Many Americans who have been sick or injured over the last year worry about the high cost of healthcare, and struggle to ensure that their care is appropriate, according to a new poll by the Robert Wood Johnson Foundation (RWJF), National Public Radio (NPR) and Harvard School of Public Health.  RWJF commissioned the poll to enhance understanding of Americans’ experiences and attitudes towards the cost and quality of medical care.

Fully 87 percent think the cost of care is a serious problem.  Approximately two-thirds – 65 percent — believe the cost of care has soared over the last five years.  In addition to the general public, the poll studied sick Americans’ experiences with and perceptions of the costs and quality of medical care.  “Sick Americans” (27 percent of adults surveyed) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring significant medical care or who had been hospitalized overnight in the past year.

Many sick Americans had problems with the cost of their own medical care.  More than 40 percent reported that the cost of their medical care has caused a “very serious” (20 percent) or “somewhat serious” (23 percent) problem for their finances.  They also reported that expensive healthcare costs affected their ability to access care.  One in six sick Americans could not get the medical care they needed (17 percent).  Among the sick Americans who could not receive care, 52 percent report that it was because they could not afford the needed care, and 24 percent say it was because their insurers refused to pay for it.  Finally, 11 percent of sick Americans said they had been turned away by a doctor or hospital for financial or insurance reasons when they tried to receive care.

One of those people is Fresno, CA resident Amber Cooper, who has health insurance from her job in the accounting department of a small manufacturing company.  Then the company changed their insurance plan.  According to Cooper, “We were in a conference room…and I had heard rumors but didn’t know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in.  Unfortunately, the rumors had come true with potentially devastating consequences for Cooper, who had a liver transplant at the age of 10 and takes a medication twice a day so her body won’t reject her liver.

Every year my company changes the insurance.  And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage,” she said.  Cooper was devastated.  Her anti-rejection medicine costs more than $1,000 a month, a price that she could not afford to pay on her own.

Cooper found help at the HealthWell Foundation, which pays for her medication.  Still, she can’t afford the $300 monthly blood test to make sure she’s not rejecting her liver.  “It is scary because the only way to tell if you’re going to go into rejection is by the blood work.  Your numbers will be a little bit crazy, and then the doctors will be like, ‘OK, you need to get in and we need to check you out and make sure you’re OK.’  So I really took a risk not getting that blood work done.  But I couldn’t afford to get it done. I really couldn’t,” she said.

Cooper isn’t alone.  Health insurance has been changing noticeably “beneath the surface,” said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. “In plain language, it’s becoming skimpier and skimpier and less and less comprehensive.  This affects not only how people seek healthcare — they’re more reluctant to get it if they can put it off.  But it also affects family budgets in a very real way, especially as we’re still coming out of recession and families are still crunched by a weak economy,” Altman said.

Paul Fronstin of the Employee Benefit Research Institute says this is a national trend.  “Deductibles have gone up. Co-pays have gone up.  You see cost-sharing for out-of-network services have gone up,” Fronstin said.  “It seems to have accelerated in the last few years.  Healthcare is just continuing to take a bigger bite out of take-home pay.”  According to Fronstin, the economy is causing more companies to cut back on coverage because of the math: It’s the only way they can keep up with rising healthcare costs.  “Employers are trying to manage those costs.  They’re trying to keep those cost increases as close to inflation as possible.  And they’re doing everything they can to get their workers to think twice about the healthcare that they are using,” Fronstin said.

New Study Reveals Where Healthcare Costs Are Rising

Thursday, May 31st, 2012

Higher prices charged by hospitals, outpatient centers and other providers drove up healthcare spending at twice the rate of inflation during the financial crisis – even as patients sought less medical care, according to the first-ever Health Care Cost and Utilization Report. According to Kaiser Health News, prices rose five times faster than the inflation rate for emergency room visits, outpatient surgery and facility-based mental health care from 2009 to 2010, according to the Health Care Cost Institute (HCCI), a nonpartisan research group funded by insurers.  Prices fell only in nursing home care, which declined by 3.2 percent in the cost per admission.  Rather surprisingly, the fastest growing spending was in children’s medical care.

“The story really does seem to be prices,” said Martin Gaynor, chair of the institute’s governing board and a healthcare economist at Carnegie Mellon University.  One of the most comprehensive analyses at real claim payments made by insurers, the study’s findings raise questions about the nation’s $2.6 trillion annual healthcare bill: Why are medical services costs rising significantly faster than inflation?  Is the fast increase in spending on children a glitch, or a long-standing drift with major implications for future costs?  “If you don’t know what the cause is, you don’t know what the right policy lever is (for a solution),” Gaynor said.

The study’s results are based on nearly three billion claims paid by Aetna, Humana and UnitedHealthcare for 33 million people with employer-based insurance.  The data represent approximately 20 percent of the people with insurance nationally, but do not include spending for people who are on Medicare, Medicaid or those who purchase private policies.

According to the report, people with job-based insurance “are paying more and getting less,” said Chapin White, a senior researcher at the Center for Studying Health System Change, a nonpartisan think tank.  Hospitals and other medical providers “just seem to be able to raise prices faster than general inflation.”

“This is an important study that clearly demonstrates that rising prices for medical services are driving health care cost growth,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans, the industry lobby. “Reducing medical costs is essential to making health care coverage more affordable for individuals, families, and employers.”

Before this treasure trove of data was available, researchers have relied on far smaller surveys of employers or on government claims statistics from Medicare, which primarily covers Americans over age 65.

Healthcare researchers have wondered why, after more than 10 years of startling growth, healthcare spending is now rising more slowly.  The researchers’ numbers lend support to one of the most popular theories: People are using less healthcare.  According to the report, between 2009 and 2010, people with employer-sponsored insurance had 3.3 percent fewer admissions to hospitals and other medical facilities, 3.1 percent fewer “outpatient” visits, and virtually no change in the number of procedures performed at physicians’ offices.  There was a slight increase in procedures performed at medical facilities, which rose by two percent, and use of prescription drugs, which went up by just under one percent.

“People had speculated that there was a decline in utilization, but by analyzing over three billion claims we now know not only the trend but the magnitude of the trend,” said David Newman, the institute’s executive director.  “It’s one thing to believe something, it’s a completely different thing to actually know it.”

If these tendencies continue, Gaynor said, “we may need to think about where we’re directing our policies” to control costs.  That’s because healthcare reform initiatives like accountable care organizations — networks of hospitals and doctors that will work together to coordinate patients’ care and cut out unnecessary services — may not help if they’re still charging more for those services.  Gaynor suggested that it might be worthwhile to keep a closer eye on consolidation in the health care sector — since larger hospitals and health systems might have the leverage to demand higher prices from insurers. He also said it might be more effective to regulate prices or increase the portion of health costs insured people pay so that they demand better deals.

Although the insurers whose data was analyzed provided “seed funding” for the study, they did not limit the questions that researchers can ask and have no control over what they produce, Gaynor said.  The group plans to update the database with more-recent claims and make the information available for further study.  “There’s been an awful lot of consolidation in certain sectors of the healthcare industry, and we know that tends to lead to higher prices, but we can’t draw any conclusions yet,” Gaynor said.

Which One Do You Like? Healthcare Insurance Exchanges or Marketplaces?

Wednesday, May 23rd, 2012

If a Medicare staff recommendation is okayed, health insurance exchanges may be re-named.  According to Kaiser Health News , that is because, Medicare officials say consumers understand words like “marketplace” better.  “We are recommending not using the word ‘exchange’” in enrollment materials, said Julie Bataille, director of the CMS Office of Communications.  While Bataille didn’t mention the preferred substitute, she dropped hints.  “Words like ‘marketplace’ resonate much more with the consumer and also tend to be something that is all inclusive,” Bataille said.

According to Bataille, “exchange” can have a number of different meanings to consumers, including the idea that they may have something to trade.  The Patient Protection and Affordable Care Act (ACA) requires the federal government to establish health insurance exchanges in states that refuse to create their own.  They are often described as online marketplaces similar to Travelocity.com or Amazon.com, where consumers can search for insurance policies that fit certain criteria.  Enrollment information will become available in the fall of 2013 and the exchanges — or whatever the ultimate name is – will start operating in 2014, unless the Supreme Court declares the law unconstitutional.

The word “exchange” appears 247 times in the ACA, while “marketplace” is not mentioned once, according to Kaiser Health News.  But that doesn’t mean officials are obligated to use it, said Brenda Cude, a professor of consumer economics at the University of Georgia and a consumer representative for the National Association of Insurance Commissioners.  “I don’t believe that Congress is any kind of expert on how to communicate with consumers,” she said.  But “marketplace” may not be a fool-proof alternative, Cude said.  She is concerned that comparing a health insurance exchange to a shopping website encourages the notion that the lowest price policy is the best choice.  That may be true when looking for a commodity like a cheap airfare to a single destination, but not for healthcare policies offering different benefits.

Bataille said the Medicare staff’s advice to avoid the term “exchange” is supported by external research and the agency’s focus group testing this year in Cleveland, Dallas, Miami, Philadelphia and Phoenix.  CMS “routinely” tests its materials and websites with consumers “to make sure we are serving our beneficiaries as well as possible,” Bataille said.  “So we see our work on the exchanges as an extension of that.”  According to Bataille, CMS will seek public comment on the enrollment materials before finally deciding whether to use the word “exchange” or “marketplace”.

Healthcare Employment on a Strong Growth Trajectory

Monday, April 16th, 2012

Healthcare employment will continue to grow much faster than employment in general, with the number of jobs in home care and other ambulatory settings expected to grow by more than 40 percent by 2020, according to a new study from the Center for Health Workforce Studies (CHWS) at the State University of New York at Albany.

Recent statistics from the Department of Labor focus on an expected hiring shift away from hospitals, as the system emphasizes preventive care and fewer admissions, said Jean Moore, CHWS director.  “For a long time, acute-care services tended to trump everything else, and that seems to be changing,” Moore said.  “There’s a growing awareness that it’s penny-wise and pound-foolish not to pay attention to preventive and primary care.”

Hospitals also are expected to keep hiring — nearly one million between now and 2020 — for a growth rate of 17 percent – as baby boomers age and need more inpatient care.

Physicians’ offices and other healthcare professionals are projected to hire 1.4 million people by 2020, a 36 percent increase.  The number of home health care jobs will soar by 872,000 – that’s an 81 percent growth rate.  The total number of ambulatory-care jobs will grow by 2.7 million by 2020, or 44 percent.

According to Kaiser Health News, healthcare is projected to be a growth industry, even if the Supreme Court strikes down the Patient Protection and Affordable Care Act (ACA).  “One of the things I wasn’t expecting was how much growth there was even during the recession,” Moore said.  “I would have expected some tempering of the growth.”

Although total U.S. employment declined by two percent between 2000 and 2010, healthcare employment rose 25 percent — demonstrating the sector’s expanding share of the economy.  By 2020, nearly one of every nine American jobs will be in healthcare.  When you consider that four million new health jobs will be created and people retiring from existing ones, more than seven million new workers will be needed.  That includes more than one million nurses.

According to the report, administrative healthcare jobs were cut during the economic slump from 2008 to 2010, a time when providers added nursing and other clinical positions.  Recent reports suggest that hospitals are hiring additional administrative staff to keep up with the increased regulation required by the ACA.  “They may be rehiring the people they had to let go when times were tight,” Moore said.

Healthcare employment totaled 14.19 million in October of 2011, an increase from the 13.88 million a year earlier, according to the Bureau of Labor Statistics.  Hospital jobs increased by 84,000 during the same time period.  Ambulatory services — physician offices, outpatient clinics and home health agencies added more than 173,000 positions.

Demand is strongest for general practitioners, nurse practitioners and physician assistants at private practices, community clinics, hospitals and long-term care facilities.  Demand also is high for physical therapists.  Some analysts predict that the shortage of physical therapists will increase as healthcare reform goes into effect.  Fewer uninsured Americans translates to a greater demand for physical therapy.  In response, medical schools are expanding and developing physical therapy training programs.

If anything, the physical therapist shortage will worsen, because in 2000, 15.6 percent were between the ages 50 and 64; 10 years later, 32 percent were in that age bracket, according to a report from the American Physical Therapy Association (APTA).  Unemployment among physical therapists remains remarkably low: In 2010, only 0.4 percent — one in 250 — of physical therapists were jobless.  “Nobody knows how accountable-care organizations and medical homes will shake out, but healthcare reform in general will decrease the number of uninsured, which will increase demand for physical therapists,” said Marc Goldstein, senior director of research for the APTA.  “Physical therapy programs are being developed or expanded, so the current level of 6,000 graduates annually should creep up.”

A survey by Sullivan, Cotter and Associates, Inc., a nationally-recognized compensation and human resource management consulting firm, over the last year, nearly 75 percent of respondents reported they increased their physician staffing levels; adding an average of 12 specialists and nine primary-care physicians to their staffs.  Another 75 percent said they plan to increase their physician staffs and mid-level providers over the next year.  “These data are consistent with the labor market shift in physician employment that has been occurring over the past few years,” said Kim Mobley, practice leader for physician compensation.  “We expect this trend to continue for some time.  This shift in the labor market has resulted in what has become a highly competitive market for physicians as organizations and physicians align to provide services in a high quality, more efficient manner.”

Don’t Text and Treat: How Mobile Technology Is Distracting Physicians

Tuesday, April 10th, 2012

Dr. Henry Feldman, nicknamed the iDoctor, of Boston’s Beth Israel Deaconess Medical Center is a hospitalist and programmer who is constantly armed with an iPhone and iPad.  According to Kaiser Health News, mobile technology has helped Feldman become a better, faster physician.  “It lets me do everything I could do if I was sitting at my desktop at the patient’s bedside, and actually some things I couldn’t easily do,” he said.  According to Kaiser Health News, this includes showing patients impressive apps, diagrams, medical records and even photos from their own surgeries.  Beth Israel, one of Harvard Medical School’s teaching hospitals, is one of the most technically sophisticated hospitals in the nation, particularly in terms of mobile technology.

A somewhat different viewpoint is offered by Dr. John Halamka, the hospital’s chief information officer who helped make Beth Israel electronically advanced.  Halamka warns that mobile technology has a serious downside — it can distract doctors from patient care.  Physicians who carry mobile devices often receive texts, e-mails, Facebook messages, tweets and other notifications that automatically appear on the screen, he said.  Because the vast majority of smart phones and tablets are personal devices, the problem can be virtually impossible for hospitals to control.  “I think all of us who use mobile devices have what I will call continuous partial attention,” Halamka said.  “We’re engaged in our work but at the same time we’re checking that e-mail or we’re glancing at that instant message.”

Last winter, Halamka wrote a case study for the federal Agency for Healthcare Research and Quality about an incident in which a 56-year-old man was admitted to have his feeding tube replaced.  A team of doctors decided to stop giving the patient a blood thinner, but as one of the residents was entering the new order into her smart phone, she got a text about a party.  Because she was busy responding, she never completed the drug order.  It wasn’t a minor mistake; the patient almost died.  “If you forgot to pick something up at grocery store, it’s an inconvenience,” according to Halamka.  “If you forgot to stop a blood thinner, it can result in significant harm.”

To avoid such errors from occurring at Beth Israel, Halamka has implemented policies advising doctors on minimizing distraction on their mobile devices.  The hospital is testing software products that separate the devices’ personal and professional functions and wants to launch the new programs within the next six months.  The problem is that new technology fast outpaces the policies that regulate its use.  “The consumer technology industry is bringing more tech to doctor hands faster than policy can be made,” he said.  “How long did it take to pass laws against texting while driving,” Halamka noted.  “And we had how many people die because they were distracted drivers. There was a lag. I think maybe we’re at that point in healthcare.”

Writing on KevinMD.com, Dr. Kevin Pho “We’re encouraging more doctors to use ‘point-of-care’ apps, which, in theory, should benefit patients. But unaccounted for is the fact that smartphones and tablets carry many other functions that are non-clinical — like Facebook, for instance.  A simple answer, some say, would be to ban non-medical use of smart phone and tablet apps.  But like trying to ban texting and driving, that would be near impossible to enforce.  A better way would be to increase awareness and education of the phenomenon.  I had no idea how bad the problem was.  In medical school and residency, there are few courses on online professionalism.  Perhaps that needs to be part of the curriculum.  We need social media and health 2.0 role models who can teach physicians, residents and medical students not only how to act professional online, but also on appropriate mobile technology use in the clinic and hospital.  The problem is, there are too few of these role models.  In their absence, much of what we do to address this issue will be reactionary, and likely after a well-publicized malpractice case.”

Jonathan Mack, director of clinical research and development with the West Wireless Health Institute, a San Diego-based non-profit that focuses on cutting the cost of healthcare through new technology, believes that distraction from mobile technology “is case by case, but it’s not a huge problem overall.  It’s a learning curve” as hospitals adapt to the new technology.  Hospital administrators should be comfortable calling doctors on bad behavior if they see it and offer training so that they don’t become a barrier to care.

Writing for informationweek.com, Larry Seltzer says that “But of course, like the rest of us, doctors are going to use these devices for non-business reasons from time to time.  Yes, smart phones are especially good distractions, but it’s not like they invented distraction.  If nurses and techs weren’t playing Angry Birds 10 years ago when they had nothing to do, they might have been reading People magazine or doing a crossword puzzle.  Surgeons might not have been making personal phone calls while sewing up patients, but they might have been having personal conversations with others in the room.  What’s the difference?  There are good reasons why doctors and techs might want to access computers or the Internet while working on patients, and there are bad reasons.  These are people who we already entrust with a lot.  It’s just common sense to expect them to use these devices responsibly.”

Hedging Their Bets, Insurers Setting Up Health Insurance Exchanges

Wednesday, February 22nd, 2012

Health insurance companies are trying to play an important role in healthcare reform as the Patient Protection and Affordable Care Act (ACA) threatens to upend their marketplace in 2014 by creating their own exchanges. Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014.  According to Kaiser Health News and reported by Minnesota Public Radio, the largest insurers are creating their own private insurance exchanges to protect themselves against competition from the public exchanges.

The implementation of the ACA is the most significant change to healthcare since Medicare and Medicaid came on line in the 1960s – and the impact for health insurers is virtually unfathomable.  Less than two years from today, the federal healthcare law will bring more restrictions on premium increases, millions of new customers, and the ability for consumers to comparison shop online for the best deal on their health insurance.

According to Sabrina Corlette, research professor at Georgetown’s Health Policy Institute, these are just some of the changes coming in 2014. Just how insurance markets will shake out is anyone’s guess, she said.  “Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves,” Corlette said.  “(What) also needs to be watched closely (is) that it’s working for the consumer.”

According to the Obama administration, 28 states are in the process of establishing insurance exchanges under the ACA, despite multiple lawsuits and a spring date with the Supreme Court.  Fourteen states, including some with Republican governors, have passed legislation or have the authority in place to set up the regulated insurance markets, according to a report by the Department of Health and Human Services (HHS).  Other states have passed executive orders or authorized studies to demonstrate the value of exchanges.  The goal is to bring coverage to 16 million uninsured Americans in 50 states and the District of Columbia.

In their most recent demonstration of progress in health reform, administration officials promised to provide assistance to states that miss the 2013 deadline to ensure their participation.  “We’re going to meet states where they are, and…we’re going to work with them to get them as far down the path as we can,” said an anonymous administration official.

According to the report, some states such as Nevada, Alabama, Mississippi, all with Republican governors, and others are making significant progress.  The irony is that many of these “red” states are also suing the administration over the ACA’s constitutionality.

How does a red state that has taken a lead in lawsuits against the ACA reconcile these differences?  Writing in the Richmond Times Dispatch, Michael Martz says that “Six bills have been filed in the legislature proposing varying ways to set up a benefits exchange, which is required under the federal healthcare reform law that (Governor Bob) McDonnell opposes and the state hopes to overturn in the U.S. Supreme Court.  But the governor is discouraging legislators from approving any of the bills during this session, despite looming federal deadlines that some lawmakers and insurers fear will leave Virginia with a less-competitive federal exchange for individuals and small businesses to buy health benefits.  The state would have to submit a plan for the exchange this year to the U.S. Department of Health and Human Services (HHS) no later than January 1, 2013, to ensure that the entity can begin operating a year later.”

“There is plenty of time to act,” the McDonnell administration said in a series of “talking points” on why legislation is not currently needed.  “There is no need for members of the General Assembly to make untimely and unnecessary decisions surrounding creation of an exchange during the 2012 session.”

Hospitals, CMS Butt Heads Over Too Many Readmissions

Tuesday, February 14th, 2012

Medicare has plans to penalize hospitals that frequently readmit patients who really don’t need hospitalization. According to one estimate, this practice costs the federal government $12 billion every year.  Medicare’s goal is to persuade hospitals to be certain that patients get the care they need following their discharge.  This new policy is likely to excessively impact hospitals, particularly those that treat low-income patients, according to a Kaiser Health News analysis of data provided by the Centers for Medicare & Medicaid Services.  Hospitals that admitted the most underprivileged Medicare patients were approximately 60 percent as likely to have significantly higher readmission rates for heart failure.  At these hospitals, lower-income people comprise a larger share of the patients than they do at 80 percent of hospitals.

“When some of our patients get home, their lights and gas are shut off,” said Roland Abellera, vice president of quality and corporate compliance at St. Bernard Hospital in Chicago’s blighted Englewood neighborhood.  “So what ends up happening is that the ambulance brings them back to us and we have to house them until our staff can help them get the utilities turned on.  We have a community in need.”

Within 30 days of discharge, 25 percent of Medicare patients with heart failure are readmitted to the hospital.  The Patient Protection and Affordable Care Act (ACA) has ruled that beginning next October, Medicare will fine hospitals whose patients who have had heart attacks, heart failure or pneumonia return to the hospital too soon.  By 2014, hospitals with high readmission rates can potentially lose up to three percent of their Medicare reimbursements.

Medicare has set aside funds so hospitals can more effectively plan patients’ post-discharge care.  According to Patrick Conway, Medicare’s chief medical officer, some funds will be targeted to hospitals that serve significant numbers of poorer people.  “We especially are concerned about safety-net hospitals that take care of a high portion of patients in poverty and racial and ethnic minorities,” he said.  At the same time, his agency is committed to the readmission penalties, in part because it is the law and because it believes the penalties will persuade hospitals to be certain that patients get the follow-up care they need.

Some hospital administrators are concerned that the new policy is too harsh.  “In essence, they are penalizing those hospitals and areas that need the most help and the most money to address these issues because we have the sickest, most noncompliant and vulnerable patient population,” said Guy Alton, chief financial officer at St. Bernard.  According to Abellera, St. Bernard’s heart failure patients usually have more than one serious conditions, such as kidney failure, hypertension and diabetes.  “A patient does not come here for heart failure alone,” he said.  “They have no less than six or seven diagnoses — we’ve had many with more than that.”

Dr. Ashish Jha, in the latest New England Journal of Medicine, makes the case that readmissions aren’t the best gauge of unnecessary care — even though they’re a natural target for budget-cutters.  The Harvard University professor points out that many hospitals with the highest readmission rates serve the poorest areas with the biggest health problems.  “Readmissions are caused by what hospitals do, who the patients are, and what’s happening in the community,” he says. “You want hospitals to fix the things they can, but you don’t want to punish them for taking care of poor people, and you don’t want to punish them for being located in a poor area.”

Two of the most frequent reasons for hospital readmissions are medication errors and failure to see a physician – both of which could be reduced if patients were supervised through home care visits following discharge.

Public Perceives Supreme Court Justices As Biased Over ACA’s Legality

Monday, February 6th, 2012

Approximately 60 percent of Americans believe that the Supreme Court justices who will hear the Patient Protection and Affordable Care Act (ACA) will base their judgments more on personal ideology than a legal analysis of the individual mandate, according to a recent Kaiser Family Foundation poll.

Only 28 percent believe the justices will base their decision on the mandate without regard to politics and ideology.  The poll also asked about general views of the Supreme Court and found that 75 percent of the public believe that justices sometimes let their personal politics sway their decisions.  Seventeen percent said justices more often than not decide cases based on legal analysis.  The court is expected to hear oral arguments in March in a case brought against the Patient Protection and Affordable Care Act (ACA) by 26 states.

The Kaiser poll found that the individual mandate, a requirement that most Americans purchase health insurance by 2014 or pay a fine, remains unpopular — 67 percent of Americans opposed the provision and just 30 percent supported it.  Overall, approximately 37 percent of Americans view the health law favorably, while 44 percent have an unfavorable view.

In terms of the “repeal and replace” agenda that House Republicans are pursuing, it’s not really winning over the public.  According to the Kaiser poll, 50 percent of respondents would prefer to expand the law or keep it in place; just 40 percent want to repeal it outright or replace it with an alternative.  That could be a problem, since House Energy and Commerce Health Subcommittee Chairman Joe Pitts said that a “replace” plan is on the subcommittee’s to-do list, at approximately the same time that the Supreme Court is expected to rule.  Pitts hopes that his caucus will be able to seize the opportunity to sway public opinion: “We’ll have a window of opportunity to — with everyone looking — to explain that the Affordable Care Act is not fully implemented yet.  A lot of people think it is.  So we’ll use that opportunity in that window to discuss the full ramifications of the Affordable Care Act and what we’ll replace it with.”

For example, Justice Elena Kagan (who was Solicitor General at the time the ACA was passed and has recused herself from the Supreme Court case) and noted Supreme Court litigator and Harvard Law Professor Laurence Tribe, who worked for the Justice Department at the time, had an email exchange in which they discussed the pending healthcare vote.  “I hear they have the votes, Larry!!  Simply amazing,” Kagan wrote to Tribe in an email.

“So healthcare is basically done!” Tribe responded to Kagan.  “Remarkable.  And with the Stupak group accepting the magic of what amounts to a signing statement on steroids!”  The “Stupak group” refers to then-Representative Bart Stupak (D-MI), who masterminded a group of House Democrats who had indicated they would not vote for the ACA if it permitted federal funds to pay for abortions.  Ultimately, Stupak and his allies voted for the bill, even though no additional language was added that would prevent federal funding for abortions.

Writing for KSL.com, contributor Curt Mainwaring muses on what will happen if the Supreme Court upholds the ACA. “If the Supreme Court rules that ACA is constitutional, healthcare costs will likely continue to rise — although at a slower rate than if the law were determined to be unconstitutional.  Healthcare costs currently make up approximately 18 percent of gross domestic product.  If expenditures continue on their current trajectory, ‘the share of GDP devoted to healthcare in the United States is projected to reach 34 percent by 2040.’  In more intimate terms, the Department of Health and Human Services demonstrates individuals paid approximately $1,000 per year in healthcare costs in 1960, more than $7,000 per year in 2007, and are projected to pay more than $13,000 per year by 2018.

“Simply put, this kind of a rise in healthcare costs is unsustainable — and these kinds of projections are part of the reason ACA was created in the first place.  Nevertheless, claims of ACA’s positive impact on the economy have likely been overestimated.  ACA focuses heavily on reducing the cost of health insurance — a factor that will likely result in reduced insurance costs.”